scholarly journals A Feasibility Study of Primary Care Liaisons: Linking Older Adults to Community Resources

2021 ◽  
Author(s):  
Allison M. Boll ◽  
Melissa R. Ensey ◽  
Katherine A. Bennett ◽  
Mary P. O'Leary ◽  
Breanne M. Wise-Swanson ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Feasibility Study ◽  
Community Resources

scholarly journals Demonstrating a Technology-Mediated Intervention to Support Medication Adherence in Community-Dwelling Older Adults in Primary Care: A Feasibility Study

2019 ◽  
Vol 5 ◽  
pp. 233372141984517
Author(s):  
Henry Yu-Hin Siu ◽  
Bethany Delleman ◽  
Jessica Langevin ◽  
Dee Mangin ◽  
Michelle Howard ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medication Adherence ◽  
Older Adult ◽  
Feasibility Study ◽  
Clinical Work ◽  
Medication Administration ◽  
Recruitment Rate ◽  
Community Dwelling ◽  
Adherence Rate

Background: Medication non-adherence can lead to significant morbidity and mortality. This 4-week feasibility study aims to demonstrate that the eDosette intervention can be implemented with older adults in primary care. Method: Fifty-six older adults from four primary care sites in Southwestern Ontario, Canada participated. The intervention involved generating, for pharmacist review, weekly medication administration records based on transmitted data captured by the eDosette. The primary outcome is implementation feasibility defined by recruitment, adherence rates, frequency of captured missed and late doses, descriptions of clinical work resulting from the intervention, and participant feedback. Results: The recruitment rate was 24% (57/240); one withdrew due to personal reasons. The mean observed adherence rate was 82% (range 49%-100%). Overall, participants missed 505 and took 2,105 doses late; 118 clinical decisions occurred with 72 unique medication changes in 31 participants. Participants found the eDosette easy to use and did not feel that they were viewed negatively because of their potential non-adherence. Conclusion: The eDosette intervention could be feasibly implemented in primary care with older adults. Providing information about when an older adult takes their medications could play a role in medication adherence by prompting more informed discussions between the older adult and primary care clinicians.

Measuring the Implementation of Lifestyle-Integrated Functional Exercise in Primary Care for Older Adults: Results of a Feasibility Study

2019 ◽  
Vol 38 (03) ◽  
pp. 350-366 ◽  
Author(s):  
Jenna C. Gibbs ◽  
Caitlin McArthur ◽  
James Milligan ◽  
Lindy Clemson ◽  
Linda Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Feasibility Study ◽  
Qualité De Vie ◽  
Personnes Âgées ◽  
Mode De Vie ◽  
Mise En Œuvre ◽  
Functional Exercise

RÉSUMÉNotre étude pilote a évalué la faisabilité, l’efficacité et la mise en œuvre du programme d’exercices fonctionnels en groupe intégrés au mode de vie (Lifestyle-integrated Functional Exercise; Mi-LiFE) créé pour des personnes âgées, dans le cadre d’une pratique interprofessionnelle en soins de première ligne. Un physiothérapeute a enseigné aux participants comment intégrer des exercices de force et d’équilibre dans la routine quotidienne au cours d’une séance individuelle et de quatre séances de groupe, suivis de deux rendez-vous téléphoniques. Les résultats concernant la faisabilité incluaient le recrutement, l’adhésion et la rétention sur une période de six mois. L’activité physique (AP) (accéléromètre, IPAQ), une version courte de la batterie de tests de performance physique (SPPB) et la qualité de vie liée à la santé (EQ5D-3L) ont été évaluées au début de l’intervention et 6 mois plus tard. Des 123 personnes admissibles, 39 % ont participé à l’intervention et 61 % n’étaient pas intéressées ou non joignables. Quarante-huit participants (âge moyen ± ÉT = 81 ± 5 ans ; IMC = 28 ± 5 kg/m2 ; 60 % de femmes ; AP modérée à vigoureuse = 49 ± 87 minutes par semaine) ont pris part à cette étude. Quatre participants se sont retirés avant le début de l’intervention. Trente-deux participants (67 %) étaient présents au suivi. Le taux d’adhésion quotidien documenté dans le journal de bord était de 50 % à 6 mois, et 77 % des participants ont assisté à au moins 4 séances. Aucun changement statistiquement significatif n’a été observé dans les résultats de l’AP modérée à forte et de la SPPB. Cependant, les participants ont déclaré lors du suivi que leur force et leur équilibre dans l’AP se sont améliorés, tout comme leur qualité de vie. Le programme Mi-LiFE présente une bonne faisabilité, avec des taux de recrutement et d’assiduité acceptables. Des modifications pourraient être apportées pour améliorer la rétention et l’adhésion à l’intervention. Ces résultats renseignent sur la faisabilité de programames d’exercices pragmatiques qui pourraient être développés pour être offerts aux personnes âgées se présentant pour des soins de première ligne.

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

scholarly journals Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam

2021 ◽  
Author(s):  
Noah A. Schuster ◽  
Sascha de Breij ◽  
Laura A. Schaap ◽  
Natasja M. van Schoor ◽  
Mike J. L. Peters ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medical Care ◽  
Help Seeking ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Hospital Outpatient ◽  
Longitudinal Aging Study Amsterdam ◽  
Aging Study ◽  
Longitudinal Aging Study

Abstract Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.

scholarly journals Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Victoria Grando ◽  
Roy Grando
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Neurocognitive Disorders ◽  
Mental Condition ◽  
Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

scholarly journals Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Melanie Krüger ◽  
Anna Gabriel ◽  
Joachim Hermsdörfer ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Older People ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Main Trial ◽  
Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

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